Therapy of acute kidney injury in the perioperative setting

Abstract

Cardiac surgery is responsible for the highest risk of renal dysfunction with respect to other surgical settings. A number of different and coacting insults, including toxins, renal hypoperfusion, ischemia-reperfusion injury, and systemic inflammation, are leading causes of this frequent complication. Intense research is ongoing on the treatment of established cardiac surgery-associated acute kidney injury and, in this view, a holistic approach including preoperative data, risk stratification, prevention, timely diagnosis, and aggressive intervention can limit the burdening consequences of renal dysfunction in these patients. Although no specific pharmacologic and nonpharmacologic strategy can be currently recommended outside clinical research, the prompt identification of renal dysfunction and the application of multimodal treatments are fundamental aspects. Right ventricular dysfunction and increased central venous pressure, frequently affecting cardiac surgery patients, potentially lead to congestive renal dysfunction. Hemodynamic management covers a central role in these cases.

Perioperative Acute Kidney Injury

“…105 Although numerous agents have shown promise, a single strategy toward improving treatment options for acute kidney injury has failed to demonstrate utility in clinical care. [106][107][108][109] This continues to be an area of intense research with numerous ongoing translational and clinical trials (Supplementary Digital Content 3, http://links.lww. com/ALN/C57).…”

Pharmacological interventions for protecting renal function after cardiac surgery: a Bayesian network meta‐analysis of comparative effectiveness

“…The aetiology of acute kidney injury after cardiac surgery is known to be multifactorial and includes inflammatory response, oxidative stress, transient haemodynamic derangement and ischaemia‐reperfusion injury . Many pharmacological agents targeting the different causes have been tested for their ability to protect renal function after cardiovascular surgery . However, previous randomised controlled trials (RCT) of these drugs were mostly small and had limitations.…”

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

“…In addition, AKI occurrence is also surgery related. Cardiac surgery has an AKI incidence as high as 30% [6]. Patients' clinical characteristics and procedural-related factors favoring AKI in cardiac surgery are listed in Table 1.…”

“…Patients' clinical characteristics and procedural-related factors favoring AKI in cardiac surgery are listed in Table 1. Among them cardiopulmonary bypass is a principal contributor [6,12,13]. In vascular and cardiac surgery, aortic cross-clamping may predispose to AKI by both abolition of arterial flow and embolization [13].…”

“…Approximately 30-40% of all cases of AKI occur after surgery and postoperative AKI incidence has been described in the range between 18 and 47% [5]. Noteworthy, early identification, diagnosis, and renal support strategies are key steps since specific treatment options for kidney failure are very limited [5,6].…”